Low-Income Neurodiversity Counselling Intake Form

By checking the nearby box, I acknowledge that I understand the following:

Information submitted through this form is collected for the purpose of responding to your inquiry, determining program eligibility, and facilitating counselling intake where appropriate.

By submitting this form, I consent to the collection and use of my personal information for these purposes.

I understand that this form is not intended for the sharing of urgent or highly sensitive clinical information. While Neurodiversity Aware Counselling takes reasonable steps to protect your privacy, online forms are not fully secure communication channels.

I understand that form data is stored on secure third-party platforms used to support clinic operations. Information will only be accessed by authorized staff and clinical supervisors where necessary and will not be shared externally without my consent, except where required by law.

If you are experiencing an urgent mental health crisis, please contact 988 or local emergency services rather than using this form.

For questions regarding privacy or data handling, please contact: info@neurodiversityawarecounselling.com